Warts & That Thing

Note: Names, Country or origin and certain details represented here have been changed to protect people's identities.

A mother and her daughter are in room number three of the small emergency department, waiting. The doctor, a tall, kind man in his fifties, had already talked to the mother, a very small Ecuatorian woman, with his broken Spanish. "I have already asked them why they are here but I'd like to ask them again if they already tried going to the girl's pediatrician," the physician tells me when I arrive. I am a Spanish medical interpreter working at a hospital frequently flooded with faces and languages from other lands. A nurse enters the room right after I do. She stands beside the doctor, arms crossed, her head inclined forward, her eyes looking straight at the mother above her specs, waiting for something, almost predicting what that something will be. 

"Does your daughter have a pediatrician? Has she seen the pediatrician for this?" the conversation between the physician and the patient's mother begins.

"Yes, we tried," the woman answers. "But the next appointment is very far away, not until the end of the month, so I decided to come here."

"That's it! I'm outta here! I'm not gonna stand this," the nurse says, disgusted at a mother that, for some reason, she has deemed terrible. It's a strange reaction, I think to myself, and I cannot yet understand what has triggered it.

"So tell me what's going on," the physician continues casually, ignoring the episode. "You speak English, right?" he says, this time directing his attention not to the woman, but to her daughter, an eleven-year-old.

"Yes."

"Why did your mother bring you here today?"

The girl purses her lips and moves them right and left on her face, seemingly uncomfortable at something. "It's my thing," she begins, pauses, purses her lips some more, turns her head to the side and down, and then resumes, "My thing.... My thing that's private, the private part? It itches and itches."

"How long has this been going on?"

"For a few days."

"Two days? A  week? A month?"

"A month, yes," the girl concedes.

"Are you sexually active right now?" the physician asks next.

"No-oooo," the girl whines, looking at the doctor, cringing, saying "Are you crazy?" with her eyes.

Her mother, a stern look on her face, her teeth clenched, has been looking as if something has been bothering her all along. When she finally dares speak, she turns to me and says: "I think this should be said in Spanish, so I can understand too." I immediately communicate her wish to the doctor, who seems okay with it and begins including the mother in his glances. "Are you feeling pain in the area?" he asks the girl, this time allowing time for me to interpret the interaction to the mother. "No," the girl replies. "She has red warts in the area," her mother volunteers. An eleven-year-old with vaginal warts? I think, my own naiveness and ignorance surfacing. Can an eleven-year-old develop vaginal warts? Under what circumstances? I wonder. Is the mother hiding some terrible secret? Is the girl?

"Do you have warts there?" the doctor asks.

"No-oooo!" the girl says.

"Well, I'm gonna have to look, unfortunately," he informs her. 

I explain this to the mother. "Is he going to look at my thing?" the girl asks her. "Will you be here with us too? Can you be here?" her mother asks me. Maybe the nurse can be there if you want to, I tell the mom. "You'd have to ask her." And yes. The eleven-year-old, like an average pre-teenager is, at this point, looking mortified. "I have to take off my panties too?" she asks her mom.

"Of course."

"No-ooo! Mom!"

Meanwhile between the halls of the ER department, not far from the girl's room, the same nurse who had previously fled the room, can be heard protesting to the physician. "How inappropriate!" she is saying. "Only 'cause she didn't want to wait for the appointment she brings her daughter to the emergency room for something that's not urgent, she's had that for a month, that's how urgent it is, now she wants some doctor to check her daughter's crotch. What kind of a message is she sending her daughter? That anyone can come and touch her and look at her crotch anytime they want to? How irresponsible that woman! The kid's gonna be terrified. Imagine."

"I'm going to have to look at her," the physician shares with the nurse glancing at me as if excusing himself for having to do something he, too, feels uncomfortable doing under the circumstances. "I know it's kind of mortifying for the girl. Maybe you want to do it instead?" he asks the nurse.

"Nope! I'm not doing anything," the nurse replies.

In a couple of minutes the doctor returns to the room. The girl waits behind closed curtains. Outside, holding the curtain in place stands the girl's mother. "Are you ready?" calls the doctor. "I'm just going to look, OK? I'm not gonna touch you."

"Do I have to take my panties off too?" the girl asks the doctor.

"I'm afraid so," he replies.

"Oh, Mom!"

"She wants to get some kind of blanket to cover herself," the mother says.

"If you have warts I have to look," the doctor tells the girl.

"No-ooo," she whines.

"Alright, let's do something else. I won't look. How about you telling me if you see red warts there? Do you?" the doctor says, talking to the girl through the curtain.

"Do you have warts there?"

"No-o!"

The doctor stands behind the curtain, deciding what to do next, "Alright, you know what? I'm just gonna call your pediatrician and let her know you were here and that you're gonna call her tomorrow to see if she can give you an appointment for sooner. I'm also going to give you one pill, for the itching, that you're gonna take tonight only, okay?"

"He's not going to look," I tell her mother, and I interpret the rest for her. The physician leaves the room. When someone returns it is the nurse, holding the prescription for the pill and the discharge papers.

"You dodged that ball, kiddo!" she tells the girl. "You don't have to do anything you don't want to do, you know? You don't have to be showing that to anyone you don't want to. Got it?"

As the nurse gives the mother the instructions about the pill she has to buy, and informs her that she is supposed to call her daughter's pediatrician first thing in the morning the next day, not once does she look at the mother's eyes. She answers questions perfunctorily, staring up to the ceiling or far away as she does so, twisting and turning her eyes to avoid contact with this mother whom she judges so harshly. "Oky-doky… That's all," the nurse says. "You're great kiddo! Have a nice summer!"

The girl thanks her and smiles triumphantly walking out of the room. The mother is stoic. She stands still, at first, staring down at the floor without blinking even, then up at the eyes of a nurse who continues to refuse  acknowledging hers. My eyes, the eyes of a third person, witness of a drama seldom seen by another, aside from the usual protagonists of this real-life play, bounce between mother and nurse, floating on the tension in the air and what feels like a silent battle where Nurse, standing for the system the mother trusted so much as to take her daughter in on a holiday---expecting, at least, respect, ideally, solidarity---remains disgusted by The Mother--the Other, the strange foreigner with strange customs she cannot even fathom trying to understand. 

The mother stares at the nurse. "Bye-bye!" the nurse fans her off, like a farmer a crazy hen, a pest, not lifting for a moment her sight from the document she's writing on. The language barrier hasn't been an obstacle for the mother to understand the nurse's judgement. Still hesitating the mother stands there, a few steps from the nurse, almost begging for her care-giver's approval, oblivious or persistent in spite of the fact that neither approval nor sympathy, or any kind of yielding, she will find today.

Watching the scene unfold I am troubled and fascinated all the same. It's the human condition, I think, in all its glory---simple and complex, rendered not in black and white but in those annoying grays. Yet what kind of condition? I wonder. A mother so worried about her daughter that she decides not to wait for a far away appointment? Perhaps a mother who is hiding a step dad abusing her daughter? Or one hiding the shame of a precocious daughter? I want to save the mother from the nurse but I know neither whom I would be saving nor what that would entail, really.  Is this a teenager who is already exploring her sexuality with a boyfriend? Is this just an ultra-conservative nurse or one, otherwise well-intentioned caregiver, nonetheless with a deep prejudice against a whole generation of Latina immigrant mothers and their cultural ways? It's funny that, from my cultural vantage point, a Puertorican interpreter who grew up in a rural barrio, the mother had even seemed like a progressive Latina who could talk about things like warts and sex in front of a male doctor. Growing up, I didn't know many women in my family who could do that even reasonably comfortably.

Finally, the Ecuatorian mother utters a hesitant thank you that is never welcomed. Chin down, she finally turns away and tells me, "These things are very important to me, you see? She's had this for a long time now."

"I know you're very worried," I tell her, trying to do something to make her feel a bit better, suspecting that she has meant well, and that she has been misunderstood.  "I think that's understandable," I say.

In this tale, that's the injustice. Maybe. But what about the warts? What's the role of the warts in this story? Why would a mother bringing her daughter to the ER instead of the girl's pediatrician, on a holiday, to take care of a non-emergency situation, weighs more than the possibility that an eleven-year-old has vaginal warts and all that such a diagnosis might mean? 

"That's what happens everyday in the ER," my husband, a physician, and his friend, an ER doctor, tell me during dinner after I recount the story. "Everybody's worried more about hurrying up and getting the person who's not having an emergency out the door as soon as they can. She couldn't even get an appointment with a pediatrician when she should. The system is broken," they agree.

After the judgment call is made, the injustices can be identified. That's the easy part, I think. As I walk out of the hospital I'm worried more about the puzzle piece---that piece that lies beneath, on another level, a deeper one---that we might have missed. 

Note: Details have been changed to protect the identity of the people depicted.

Image Credit: Wikimedia Commons, "Eisenbahn" (1873) by Edouard Mane